(3) Biological therapies

Drug therapies (1)

The term ‘psychotic’ refer to psychosis. A person with psychosis experiences some loss of contact with reality, for example hallucinations or delusions.Psychosis is a defining characteristic of schizophrenia.

 

The most common treatment for schizophrenia involves the use of antipsychotic drugs.

Drug therapies (2)

Antipsychotics may be required in the short or long term. Some people can take a short course of antipsychotics then stop their use without the return of symptoms.

 

Other people may require antipsychotics for life or else face the likelihood of a recurrence of schizophrenia. Antipsychotics can be divided into typical (traditional) and newer atypical or second generation drugs.

Typical antipsychotics (1)

Typical antipsychotics have been around since the 1950’s and include: Chlorpromazine

Typical antipsychotics work by acting as antagonists in the dopamine = chlorpromazine blocks dopamine receptors, reducing neurotransmitters activity and symptoms.

• reducing the impact of hyperdominergia.

Typical antipsychotics (2)

Has a dosage of up to 1000mg a day, they reduce psychosis and have sedative properties that may not be helpful on a day to day basis.

Chlorpromazine is used not only to calm people with schizophrenia but also with othe conditions.

 

• It can be given to people who have been admitted to hospital and are very anxious

Atypical antipsychotics (1)

second generation - have been used since the 1970’s to improve the effectivness of drugs in suppressing the symptoms of psychosis and also minimise the side effects of the drugs used.

Clozapine: binds to dopamine receptors but also works on sertonin and glutamate. May improve mood and cognitive functioning (but potentially fatal blood poisoning)

Developed in 1960’s, withdrawn in the 1970’s due to the deaths of some patients from a blood condition called agranulocytosis, and remarketed in the 1980’s (seen as more effective than typical antipsychotics

Atypical antipsychotics (2)

• people today who take it still have regular blood tests to ensure they are not developing agranulocytosis.

• During the synapse it blocks dopamine receptors. Also affects serotonin and glutamate (receptors) transmission. (If you have someone who is co-morbid, could be a good suggestion for heir symptoms)

• maximum daily dose is 900mg

• If an individual is high risk for suicide - nearly 50% of schizophrenics are, so this psychotic may help, clozapine has. A mood enhancing effect.

Atypical antipsychotics (3)

Risperidone: most recent binds to dopamine receptors more strongly than clozapine does, so smaller dose and fewer side effects, have been around since 1990’s.

• Closing of the sites and helping that person not hallucinate, binds to dopamine receptors

• It was developed in an attempt to produce a drug affective as clozapine but without its serious side effects.

• Daily max dose of 12mg

A03 - strength

One strength of antipsychotics is evidence to support their effectiveness.

 

There is a large body of evidence to support the idea that both typical and atypical antipsychotics are at least moderately effective in tackling the symptoms of schizophrenia.

 

Thornley (2003) reviewed studies that had compared the effects of chlorproamzine with a control condition.

 

Data from 13 trials with a total of 1121 participants showed that chlorpromazine was associated with better overall functioning and reduced symptom severity as compared to placebo.

 

This means that, as far as we can tell, antipsychotics work.

A03 - limitation

One Limitation of antipsychotic drugs is the likelihood of side effects.

 

Typical antipsychotics are associated with a range of side effects including sleepiness, weight gain

 

Long term use can result in tardive dyskinesia, which is caused by dopamine (DA) supersensitivity and symptoms include involuntary facial movements such as grimacing, blinking and lip - smacking.

 

The most serious side effect of antipsychotics (partiucalry typical psychotics) is neuroleptic malignant syndrome (NMS). This is believed to be caused when the drug blocks DA action in the hypothalamus, an area in the brain associated with the regulation of body systems (homeostasis).

 

NMS results in high temperature, delirium and coma, and can be fatal. Estimates of its frequency range from less than 0.1% to just over 2%.

 

• do harm as well as good

A03 - limitation

It is widely believed that antipsychotics have been used in hospital situations just to calm people with SZ and make them easier for staff to work with, rather than for the benefits to the people themselves.

 

In a review, Moncrieff (2013) argues that antipsychotics have historically been used to suppress disturbed or aggressive behaviour, making patients easier for hospital staff to manage rather than solely treating their symptoms.

 

She describes this as a ‘chemical cosh’, suggesting that the drugs may prioritise the convenience of staff over the individuals wellbeing.

 

This challenges the effect bends and ethical justification of the drug therapy because sedating a patient is not necessarily the same as treating the underlying symptoms of SZ.